A heavy load (Picture by Halimaton Saadiah Sulaiman)

Recognising obesity as a medical condition could prevent a host of diseases, especially in cases where being overweight is due to genetics.

OBESITY has been described as an epidemic, with the global rates increasing significantly over the past several decades.

According to the World Health Organisation, worldwide obesity has nearly tripled since 1975.

In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.

The major issue with obesity is that it brings along a host of diseases including diabetes, hypertension, heart disease, certain types of cancers, sleep apnea, osteoarthritis, fatty liver disease and kidney disease.

The World Obesity Federation has declared that obesity fits the definition of a chronic, relapsing, progressive disease. It adds that for effective prevention strategies, obesity must be recognised as a disease.

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The Federation says recognition could allow people who are suffering from obesity access to medical treatment. It may also have benefits in countries where health service costs are funded by insurance schemes that limit payments for non-disease conditions or risk factors.

To date, only a few countries, through their medical bodies, acknowledge obesity is a disease. These include Portugal, which has recognised obesity as a chronic disease since 2004; the Scottish Intercollegiate Guidelines Network since 2010; the American Medical Association in 2013; and the Canadian Medical Association in 2015.

Malaysia has the highest obesity prevalence in Asia. According to the National Health and Morbidity Survey 2015, obese Malaysians make up 17.7 per cent of the population while 30 per cent are those who are categorised as overweight. It also shows that the prevalence of overweight and obesity had increased 80.7 per cent and 302 per cent respectively in just under two decades.

Despite the alarming increasing rate of obesity, which also leads to increasing rate of the obesity-linked diseases, Malaysia is yet to declare obesity as a medical condition. Instead, it is identified as the risk factor for related diseases.

COMPLEX ISSUE

Sunway Medical Centre’s consultant general, bariatric and medical surgeon Datuk Dr Tikfu Gee says one of the reasons obesity is not identified as a disease is because many people believe that it is self-inflicted, and also an “image” problem.

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He says due to the misconception, they believe that obese people are at fault for the excess weight because of an unhealthy diet and sedentary lifestyle. As such, it should not be medically treated. The argument is they should be able to lose weight through exercise and diet.

However, Dr Gee says diet and lack of exercise are not the only cause of obesity. There are many other unknown reasons behind the problem, although there are two causes that have been identified — lifestyle issues and genetics. Even then, he says, there is still a grey area between the two as there are overlapping cases.

“There are still a lot of things we don’t understand about obesity. It is a complex disease that needs a multidisciplinary approach to handle it. There is a prevention stage and there is a treatment stage.”

If the person is obese due to an unhealthy diet and sedentary lifestyle, he can lose weight only with lifestyle modifications, and chances are he will be able to maintain the loss.

Unfortunately, for people with a genetic predisposition, it can be more complicated and difficult.

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He says that their bodies tend to store fat more, especially when they are on a diet. The body will think that it is starving so it will store more fat. If they lose 2kg or 3kg, it already reaches a plateau as the body tries to adapt and adjust to the less food intake. So no matter how much they exercise or diet, they won’t be able to lose weight.

“They have to be very careful about their diet, which should start from young. Parents must be responsible for their children’s good eating habit. They don’t need a doctor or dietitian to tell them.

“Decades ago, children’s food consisted of rice with fish and vegetables. Now it’s chicken nuggets. They eat nuggets at home and at school. Parents buy chicken nuggets at night markets. Our diet has changed in the last 40 years, resulting in increasing rate of obesity.

“The way we cook our food has also changed. Now there are more fried foods, with sugar and salt. As our diet has changed, you must know your risk. If you have this genetic predisposition, you need to be very careful with what you eat.”

TREATMENT OPTIONS

Dr Gee says there are treatment options for obesity that include lifestyle modification, pharmacotherapy and surgery.

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For those with Body Mass Index of less than 27, a lifestyle modification with the drug liraglutide works for their obesity management. Liraglutide is a prescription medicine that can regulate appetite. However, for those who have a high BMI, surgery is the answer as lifestyle modification will no longer work.

“I had a patient with BMI of 55 and advised him to go for surgery because it was impossible for him to lose weight with just diet and exercise. He did not want surgery because people told him that he could lose weight with lifestyle changes. Two years later he decided on surgery because he could not lose weight. At that time, his BMI had increased to 58.

“On the day of the operation, he collapsed and died of a heart attack. I blame those people who wasted his time for two years.”

There are two types of surgery that are usually performed as a weight loss treatment — a gastric bypass or a sleeve gastrectomy. In the gastric bypass, which is suitable for those who have diabetes and acid reflux, a small pouch is created by dividing the upper stomach. A section of the small intestines is attached to the pouch which allows food to bypass the lower stomach and lead to weight loss.

A sleeve gastrectomy is performed by removing 80 per cent of the stomach. The smaller stomach cannot hold much food and also induces a smaller appetite. A patient will eat only one fifth of his meal, which will result in weight loss. About 70 per cent of patients prefer the sleeve gastrectomy.

Dr Gee says many think surgery is the easy way out for people who don’t want to diet and exercise, unaware that it is the only way to save a person’s life.

“Unfortunately, there are people who do not understand the issue. They are ignorant of the problem because in these cases losing weight is not as simple as dieting and exercising. If obesity is not due to genes, then why do some people not gain weight no matter how much they eat?

“I am not saying that everyone should go for surgery. Prevention is still the best way to stop obesity. However, for some people, treatment is the only way to help them.

“In my opinion, obesity should be considered a disease because once it is treated, we are eliminating all the other obesity-linked diseases.”

SIMPLE INDEX

BODY mass index is a simple index commonly used to categorise whether an adult is overweight or obese. It is a measurement of a person’s weight with respect to his height.

According to the World Health Organisation, Asians with a BMI of 24 are considered as overweight compared to a BMI of 30 in the Western population. This is because Asians have more visceral fat which increases the risk of heart diseases and diabetes.

As such the classification for Asians based on BMI as follows :

* Overweight: BMI between 24 and 26.9

* Obese class I: BMI between 27 and 31.9

* Obese class II: BMI between 32 and 36.9

* Obese class III : BMI greater than 37

The waist circumference should be less than 90cm (men) and 80cm (women).

Source : asiaief.com

kasmiah@nst.com.my